16 year old with enlarged liver. Please share if you have similar experience

My 16 year old Himalayan has been constipated and not eating as much for the past couple of weeks. And I can feel that his stomach is bloated.
Went to the vet yesterday, got blood work and x-Ray done. X-Ray shows an enlarged liver pressing onto the stomach and intestines, that's why he has not been eating much lately. Lucky he did not have lots of feces stuck in the intestine. Vet put him on laxative and vitamin B. And temporarily on the Hill's ID plus AD diet.
Blood work came back and showing abnormal results for liver, pancreas and kidney.
We will have ultrasound done next week.
I am so worried now. I know he is old and I don't even know if he will survive the anesthetics used for ultrasound.
Just want to share and see if anyone has similar experience.

He has fluid in his abdomen? So does my Etta. She's 13 and was really thin, hyperthyroid with too fast heart beat and did okay in the ultrasound. They also drained some of the fluid but it does come back to some extent unless they can get a handle on what is causing it.

My guess is that the ultrasound will go okay. I'm not even sure they use any sedative to do that, but I suppose something is offered or most cats are going to wiggle around too much. 

What are the blood tests showing in terms of abnormality?

Not sure how to read. But vet told me problems with liver, possible pancreatitis, stage 3 kidney failure. I am so scared now.

Vet said they would use anesthetics for sure because he gets really aggressive at the clinic. They also want to do biopsy on the liver.

If it were me, I'd definitely want to do the ultrasound first and then discuss the biopsy after the ultrasound results are looked at.  With the pancreatitis it seems like they would want to make sure that's under control before doing a biopsy. And what is the biopsy for, do you know? And what would you do with those results as your cat's person? It might help to ask: Does the lack of a biopsy prevent treatment for the current inflammation going on? What's the risk to treating that without a biopsy?

PetMD has some information on various cat diseases. What I learned from that is stuff is usually more complicated than what you can find there. Looking at the types of liver cancer, it seems like it is a bit rare, but there are other things that could be going on. Excess copper is mentioned and that is also confirmed with a liver biopsy.  I have no idea but maybe the pancreatitis is causing inflammation in other organs like the liver but I don't know if that is always a primary condition- for example are there other illnesses that can cause pancreatitis?

I totally understand being scared. I hate it when our old friends are ill. It's difficult when the stakes are big. For me it helped to think about what my cat might want and what the likely outcome might be if the biopsy confirmed cancer. I went with the ultrasound because if it wasn't cancer (in my case, not definitive but not confirming that it was cancer) I thought that there might be intermediate treatments that wouldn't be invasive and she could deal with that would help her current quality of life.

Thanks Laura Mae for the reply.
I won't go for the ultrasound if they need to put him under. What's the point of doing a diagnostic if the cat dies after that? My Nuinui is pretty old now, and I want him to remember his last days on earth being calm and peaceful but not with lots of stress and fear.

I will try to talk to the vet again and see if they can use something milder then a general anesthetics but still can get the job done. If they can't I would not proceed.

Since they have confirmed the pancreatitis, I hope the vet will provide the medication he would need for that. If they can compound it or if there is a compounding pharmacy I would go with that as a vehicle for less stress on the medication. I totally understand wanting his days to be peaceful and pain free. So pain medication and medication for the inflammation would be good. It would be nice if they had a shot for the pancreatitis. That would be the least stressful than daily medication but I have no idea if that's a possibility.

I did get a pill gun for part of my cat's medication and empty gel caps. That helps the tablets go down more smoothly. The prednisone is in a liquid suspension. She doesn't seem to mind that too much. I have to wrap her in a towel like a burrito just so that she doesn't twist to get the medications in.

I am a human specialist  physician in internal medicine, not a vet, and any advice I give you should be checked with your vet.

The pathology reveals a mild nonspecific anaemia.  There is a moderate jaundice and abnormal liver function tests consistent with the liver enlargement.   There is also evidence of kidney disease with a low potassium, however I am not qualified to give an opinion on the degree of kidney failure in an old cat with liver abnormalities.  The urine is normal with no evidence of kidney disease nor jaundice.

There is a high alkaline phosphatase and, in humans, and probably in cats, this is suggestive of an obstructive component such as tumours in the liver.  I could not see any pancreatic abnormalities, the amylase and lipase were normal.

I agree that an ultrasound of the liver is indicated to pick up liver metastases (secondary deposits).  In my opinion, and referring only to a human, a biopsy of the liver may, or may not, pick up any malignancy such as metastases, however this may well be different in cats with their liver being so much smaller than humans.

The investigations done so far are incomplete and are currently not diagnostic, but reveal extensive liver disease, possibly malignancy, in a very sick cat.    You should discuss further management with your vet and you would then be in a better position to make decisions on whether or not there is a possibility of treatment. 

With best wishes,

Geoffrey